Medicine has many, but could always use more like Dr. Leape. It is a joy to work with
physicians who place patients first, work in a framework of mutual respect, and advocate
tirelessly for patient safety..

Roy Clark MD FACP DLFAPA

01/13/14

Despite his contributions to patient safety, Dr. Leape, to my
knowledge, was never in the trenches of solo medical practice in a
setting where he was the totality of the medical training,
experience, expertise, and solution in a crisis situation.
He wants more than there is.
Efforts to reduce medical errors will be successful; believing you
can prevent medical error is doomed to failure. Even the FAA
abandoned the unachievable goal of zero accidents years ago for a
more humanly pragmatic and achievable goal and process..

Meyati

01/13/14

I was with a group of women in Texas. A young pregnant one asked
what we thought when we saw the first sonogram of our first baby.
One leathered woman flately said, "We didn't have anything like
that." We all nodded. The young ones went on about modern science,
health, etc.
Her grandmother said-"I had your mother and she had you, and you
came out OK."
Another pregnant woman asked us what we thought was the most
important GYN medical break through in our lives. I said, "Air-
conditioning." All of the older women agreed. Then they said that I
couldn't know about heat, as I had my kids in CA. I told them my
first was breech. I was up 3 stories, where the heat from the other
floors made it hotter. Then it was over a 100 degrees outside, and I
watched heat lightning flash over the bay.
Then people wonder why I'd rather talk about horses, dogs, and
ships. Definately, air conditioning in labor rooms..

jz, MD

01/13/14

"Healthcare should
be a public good,
like education, with
all doctors
salaried. (When they
don't have to worry
about making money
or paying the bills,
doctors are happier,
as are their
patients."
Where in heaven's
name does this come
from. RC is correct,
Lucian never
practiced in the
real world, only in
Children's hospitals
or academia. Docs
who are salaried and
in private practices
(ie., work for a
hospital)are
definitely NOT
happier. Ask
them...they lose all
control of their
lives. The hospitals
often make demands
that are dangerous
(to patients and
physicians) and
demanding (sign off
on these PAs without
ever seeing the
patient). Physicians
might be happy if
their med education
was paid for (we are
talking about costs
much after 1959
costs), hours were
limited to 40/week
and salaries were
commensurate with
roles and
responsibilities.
These will never
happen!
No Lucian, it isn't
making money that
worries docs, it's
the paperwork, EMR
demands, medical
liability issues and
endless insurance
issues which eat up
patient-dedicated
hours. You have
these burdens
whether you are
salaried or not.
Docs can't even
"admit" a patient to
a hospital without
the possibility that
the hospital itself
will change it to an
"observation"
status, thus
adversely affecting
the patient and the
physician-patient
relationship. How
does that make a
physician "happier"?
Why don't you
interview some real
physicians in
practice instead of
these Ivory Tower
denizens?.

Rauldev MD

01/13/14

Work 12 hours a day and have time to be home to have dinner with the
family? Humm... doubtful. Not 12 hours of actively practicing
medicine..

Abraham

01/13/14

Amongst the most genuine responses read so far....
He spoke from his experience, from his heart, and what he really believed.
Many others spoke what other would like to hear.
Especially liked ....
&quot;4. If you could change or eliminate something about the healthcare system, what would it be?
The business model (for-profit and not-for-profit are all the same), especially paying fee for service. Healthcare
should be a public good, like education, with all doctors salaried. (When they don't have to worry about making
money or paying the bills, doctors are happier, as are their patients.)&quot;
Finally, would like to comment on the predatory practices of clinics, hospitals, diagnostics and insurers.....
One day, sometime in the future.... Near or far.... Each one of us will have to leave behind everything we acquired..
At that time, some thoughts will flash through, each of our conscience .... How much of what we acquired, was
from the smiles and gratitude of those we served, or, how much of what we acquired, was from the tears and
curses of those we extorted ! None of what remains, will we be able to take along at that moment...
Right now, it appears, that the whole healthcare rigmarole, revolves around the billions in profit, the millions in
compensation, and the lack of compassion for those who have less..

Alastair Laubach-Bourne

01/13/14

1. What's the biggest barrier to practicing medicine today?
"Production pressure" Exactly. The greed of people who buy up
practices the set up a medical centre employing green Drs and
creating a pressure cooker type practice that does not include
patients but just how much per minute can the practice manager get
out of the Drs and patients. Medical practice these days is no
longer what it used to be as far as healthcare goes. The method is
prescribing a drug as fast as possible and get the patient out the
door. It is absolutely impossible to diagnose or consult in ten
minutes. Many group practices are not owned by Drs many are owned by
Nurses and shrewd business people.
2. What is your most vivid memory involving a patient who could not
afford to pay for healthcare (or meds or tests, etc.) and how did
you respond?
Just didn't’ and don’t charge .
3.
Go and see a qualified alternative practitioner who can give you
better service ( reference group practice )
4. If you could change or eliminate something about the healthcare
system, what would it be?
I would ban mercenary group practices and make it compulsory for Drs
to spend at least 20 minutes with each patient so as to come to a
correct diagnoses and prescription. Too many people have died due to
misdiagnosis and wrongly prescribed drugs this has to stop.
5. What is the most important piece of advice for med students or
doctors just starting out today?
Set up a practice of a few contempories and be responsible for the
running of the practice employ an office manager to handle all the
paperwork so as to leave ones hands free to consult.
6. What is your "elevator" pitch to persuade someone to pursue a
career in medicine?
Think carefully
7. What is the most rewarding aspect of being a doctor?
Simply seeing people get back a life that illness had taken away
from them.
8. What is the most memorable research published since you became a
physician and why?
HMMMM
9. Do you have a favorite hospital-based TV show?
Wouldn't waste my precious time watching one.
10. What is your advice to other physicians on how to avoid burnout?
Take time out every day to meditate and eat well. Treat your
patients with the same respect you expect to be honored with, offer
the same care you would offer your own family.
--------------------------------------------------------------------
------------.

jo, md

01/13/14

It is not necessary to agree with Dr. Leape in order to respect his opinion. The issue of production based
vs. salaried is one iteration of an age old debate. Who is more/less virtuous, the doctor who goes home
at 5 PM because that is all he/she is paid for or the physician who sees you after hours because they are
"increasing production?".

BS BUSTER

01/14/14

''I would not willingly see an M.D. unless that M.D. was vetted by
the National College of Natural Medicine, where I work part-time as
a model and by the community-supported acupuncture clinic..''
Ms Mary Saunders,
Just stick with your herbs and weeds; you are in NO position to
judge us physicians. Next time if you get into any serious trouble,
make sure you don't come running out to any ER or hospital, will
you ?
It is nit-wits like you, politicians,lawyers and accountants who
got our profession into all this mess...

David Lubin, MD

01/15/14

So the question is... What is the most important piece of advice for med students or doctors just
starting out today?
And the answer is...
Don't let the paperwork, red tape, data collection, and bureaucratic nonsense keep you from enjoying
the reality of taking care of patients.
I just retired after 37 years of family practice. Add EMR and it was all those things that made me
decide that my 8 hours a day was enough and I had had all I could take. It's a great profession, but it's
a relief not to be responsible for patient care, what with insurance companies looking at everything we
do and non-compliant and demanding patients making our lives more miserable. Patients paid me
many compliments when they found out I was retiring, but no one ever called in the 37 years to thank
me for getting better without the antibiotics they wanted me to give them. And to jz, MD, check out
my 10 Questions, probably the first on MedPageToday, and see what a retired "real" physician had to
say..

dmendo

01/15/14

jz is right on. And
jo, the doctor may
be staying quite
late not to see
another patient but
because of all that
data entry in the
EMR which converts
doctors into data
entry clerks. Dr
Leape is well
intentioned but not
a practitioner
familiar with
reality which
reality is made
burdensome and nasty
by governmental
regulations, threats
("waste fraud and
abuse claims",
meaningless use,
PQRS,and more
nonsense all
intended to come up
with a reason to pay
docs less)the MOC
money making scam,
and insurance
nonsense. We can
only fix this by
freeing ourselves of
these shackles and
providing patients
and doctors a truly
free market in
health care. This
might mean less
money to many
doctors but all of
us (except EMR
vendors, regulators,
insurance companies)
will be better for
it. Consider the
options promoted by
AAPSonline.org and
Docs4PatientCare.

Georgia MD

01/20/14

I truly believe Dr Leape is sincere in his answers. And in a different setting, his ideal might work well. In
Norway, all doctors are government employees. They are paid a salary, benefits, holidays, and have a
guaranteed retirement. The ones I met are happy and enjoy their practices which could include traveling
to distant islands by boat or plane to provide primary care. Oddly, though no one pays directly for care
(70% income tax), the system (according to the physicians) is not overused or abused by its patrons. The
patients believe that healthcare is a privilege and they work to be good stewards of that gift. In the US,
the attitude that healthcare as a right obviates the attitude of stewardship and results in an entitlement
attitude of patients. That is where we are today in much of the US healthcare system. Without a change
in public vision and mentality towards our healthcare privilege vs right, we cannot expect the system to
prosper. And EVERYONE should pay something into the system. Whether it be copays, taxes, work
equity, everyone should have some ownership. Ownership encourages stewardship. It takes both sides,
doctors and patients, to make the system efficient and sustainable..

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